In February of 2019, the U.S. Department of Health and Human Services (HHS) announced a new model to be used for payment of emergency ambulance services. This new model is intended to allow Medicare fee-for-service beneficiaries to get the best level of care at the time and place required, while also providing the possibility of reducing out-of-pocket costs.

The model has been dubbed the Emergency Triage Treat and Transport system (ET3), and it aims to make it much easier for participating ambulance providers to team up with qualified healthcare personnel, so as to deliver treatment, either on-location or at an alternative destination. On-site treatment can be delivered either at the specific location or via telehealth procedures, and the alternative destinations can be either physicians’ offices or urgent care facilities. The specific instances where the ET3 model would apply are those pertaining to Medicare patients during a medical emergency involving 911 services.

Benefits of the ET3 Model payment system

Those ambulance service providers who are able to achieve some important quality metrics with superior performance will be eligible to receive up to 5% adjustment in their payment rates. This should encourage overall excellent performance among providers, since the  adjustment can be considered to be a significant incentive.

The medical personnel at destination facilities would not be affected by these payment adjustments, receiving their normal reimbursement, but would theoretically benefit by working with the better-performing ambulance providers, in terms of increased traffic. The intent of the quality measures is to prevent any additional burden on participants, particularly in the area of reporting requirements associated with providing care for patients.

How ET3 will be phased in

Since this program must be implemented across the entire U.S., it will take some time before it can be fully implemented. Recognizing this, the originators of the new model have determined that a phased approach is best, in terms of putting the new payment system in place. Part of the reason for this is to avoid discouraging potential participants of the program from having to do too much all at once, and the gradual implementation seems best suited to accomplish this goal.

Maximum participation in the program will be encouraged by ensuring access to model usage in all regions of the country, and by promoting the potential for ambulance providers to team up with other insurance carriers, particularly state Medicaid agencies. A series of application rounds is expected to be used in order to phase in each of the different aspects of the program, beginning with the issuance of a Request for Applications form in the summer of 2019.

This form will seek to discover all eligible those ambulance providers who are enrolled with the Medicare system, and to solicit their participation in the program. A follow-up phase which is scheduled for the fall of 2019 will see the Center for Medicare and Medicaid Services (CMS) issuing a Notice of Funding Opportunity for the purpose of establishing a number of two-year cooperative agreements with local governments and other agencies.

These agreements would be for all bodies which have the authority to answer 911 calls and dispatch Medicare-enrolled ambulance services to handle those calls. This phase of implementation addresses low-acuity 911 calls, in other words, calls where there is no immediate life-threatening situation in progress that must be dealt with. It is anticipated that high-acuity 911 calls would then be addressed at some point in the following year, in the next phase of implementation.